New Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Send a Message

Name *

E-mail

Phone

Is it ok to leave a message at this phone number?

Yes, it is ok
No, it is not ok

How did you hear about us? *

Comment or Message

Yes, I want to submit this form

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Decline

By providing your email you'll be automatically added to our mailing list which allows us to send you helpful information from time to time. Click here to decline to be added to our list.

Phone